{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:53:27Z","timestamp":1782489207230,"version":"3.54.5"},"reference-count":37,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,30]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the prevalence of malaria co-infection among patients with irritable bowel syndrome (IBS) in Yemen and to evaluate the association of systemic inflammatory biomarkers (neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV) and platelet-to-lymphocyte ratio (PLR)) with this co-infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Multicentre, cross-sectional observational study conducted between April and December 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Primary and secondary healthcare facilities across 21 governorates in Yemen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>142 consecutive adult patients (aged 18\u201370 years) diagnosed with IBS according to the Rome IV criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was the prevalence of malaria infection, confirmed by a rapid diagnostic test . Secondary outcomes included differences in NLR, MPV and PLR between groups, assessed using independent t-tests, and the diagnostic performance of these biomarkers evaluated by receiver operating characteristic curve analysis with AUC calculation. Multivariate binary logistic regression was used to identify independent predictors of malaria co-infection, adjusting for potential confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean age was 42.3 years (SD 11.7) with an equal gender distribution. The prevalence of malaria co-infection was 45.1% (64\/142). Patients with malaria positivity had significantly higher NLR (mean difference 0.56, 95%\u2009CI 0.40 to 0.72; p&lt;0.001) and PLR (mean difference 22.6, 95%\u2009CI 17.8 to 27.4; p&lt;0.001) and lower MPV (mean difference \u22120.60 fL, 95%\u2009CI \u22120.77 to \u22120.43; p&lt;0.001) compared with malaria-negative patients. In adjusted logistic regression, higher NLR (adjusted OR 3.21, 95%\u2009CI 1.89 to 5.45)\u2009and PLR (adjusted OR per 10-unit increase 4.02, 95%\u2009CI 2.24 to 7.18) were independently associated with malaria positivity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nearly half of the Yemeni patients with IBS in this study had malaria co-infection, with the highest burden in diarrhoea-predominant and mixed subtypes. Elevated NLR and PLR were strongly associated with co-infection, suggesting these readily available biomarkers could aid targeted screening in resource-limited, endemic settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-116392","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T13:25:15Z","timestamp":1777987515000},"page":"e116392","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Systemic inflammation and malaria co-infection in irritable bowel syndrome: a cross-sectional study of 142 Yemeni patients"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2266-1569","authenticated-orcid":false,"given":"Naif Taleb","family":"Ali","sequence":"first","affiliation":[{"name":"Department of Medical Laboratory, University of Lahej Radfan University College, Al Habilayn, Yemen"},{"name":"Department of Health Sciences, Faculty of Medicine and Health Sciences, University of Science and Technology, Aden, Yemen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mansour Abdulnabi H","family":"Mehdi","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory, University of Lahej Radfan University College, Al Habilayn, Yemen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radfan Saleh","family":"Abdullah","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory, University of Lahej Radfan University College, Al Habilayn, Yemen"},{"name":"Department of Health Sciences, Faculty of Medicine and Health Sciences, University of Science and Technology, Aden, Yemen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali N M","family":"Gubran","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Faculty of Medicine and Health Sciences, University of Science and Technology, Aden, Yemen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazeh Mohammed","family":"Al-Abd","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Faculty of Medicine and Health Sciences, University of Science and Technology, Aden, Yemen"},{"name":"Department of Medicine, University of Aden Faculty of Medicine and Health Science, Aden, Yemen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5504-1920","authenticated-orcid":false,"given":"Gamila Saleh","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Aden Faculty of Medicine and Health Science, Aden, Yemen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6144-4769","authenticated-orcid":false,"given":"Hana","family":"Mohsen Ali","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Aden Faculty of Medicine and Health Science, Aden, Yemen"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"2026062608313280000_16.5.e116392.1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2020.04.014"},{"key":"2026062608313280000_16.5.e116392.2","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-020-0286-8"},{"key":"2026062608313280000_16.5.e116392.3","doi-asserted-by":"crossref","first-page":"16014","DOI":"10.1038\/nrdp.2016.14","article-title":"Irritable bowel syndrome","volume":"2","author":"Enck","year":"2016","journal-title":"Nat Rev Dis Primers"},{"key":"2026062608313280000_16.5.e116392.4","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S2468-1253(16)30023-1","article-title":"Pathophysiology of irritable bowel syndrome","volume":"1","author":"Holtmann","year":"2016","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2026062608313280000_16.5.e116392.5","first-page":"334","article-title":"Could platelet indices be new biomarkers for inflammatory bowel diseases?","volume":"17","author":"\u00d6zt\u00fcrk","year":"2013","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2026062608313280000_16.5.e116392.6","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.3906\/sag-1509-44","article-title":"Relationship of peripheral blood neutrophil to lymphocyte ratio and irritable bowel syndrome","volume":"47","author":"G\u00fc\u00e7l\u00fc","year":"2017","journal-title":"Turk J Med Sci"},{"key":"2026062608313280000_16.5.e116392.7","unstructured":"World Health Organization . 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